Category: MoHealthNet Home

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) DEFINITIONS RELATED TO ANNUITIES

MANUAL REVISION #19                               

1030.030.05
1030.030.10

DISCUSSION:

The December 1973 Eligibility Requirements, IM Manual sections 1030.030.05 Definitions Related to Annuities, and 1030.030.10 Determining Eligibility for MHABD Vendor or Home and Community Based Waiver Services for Annuities that were Purchased and Began Making Payments on or after April 20, 2010 When There is a Community Spouse, have been updated to add useful information when evaluating MHABD applications, annual reviews, or change in circumstance.

When a participant reports he/she is a party to an annuity, designated staff is required to review the annuity and determine answers to questions such as:

• Who is the owner of the annuity?
• Is our participant or participant’s spouse receiving income generated from the annuity?
• Is the annuity considered to be an available resource?

Revisions have been made to the manual sections listed above to provide information necessary to assist designated staff with reviewing the provisions within an annuity that help determine its impact/if any, to the eligibility factors for MHABD programs.

Staff must continue to submit IM14 Interpretation of Policy Requests on participants and/or spouses of participants who are a party to a trust or annuity. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vm

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) MANUAL REVISIONS TO QUALIFIED MEDICARE BENEFICIARY (QMB) AND SPECIFIED LOW-INCOME MEDICARE BENEFICIARY (SLMB) SECTIONS

MANUAL REVISION #18

0865.010.05.15
0865.020.10
0870.010.00

DISCUSSION:

Updates were made to sections of the MO HealthNet for the Aged, Blind, and Disabled manual regarding Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary eligibility.

0865.010.05.15 Part A Conditional Enrollment was updated to clarify that a participant who has a Social Security Administration (SSA) Part A Conditional Enrollment status should ONLY be approved for QMB, and should NOT be approved for SLMB or SLMB2. SLMB and SLMB2 will not pay the Medicare Part A premium for the participant.

0865.020.10 Filing a QMB Application was updated to remove outdated language and update processing information.

0870.010.00 SLMB Eligibility Requirements was updated to clarify the eligibility requirements are the same as QMB eligibility with the exception of income limits and that Part A Conditional Enrollment status is not valid Part A eligibility for the SLMB program. Policy was also updated to remove obsolete information regarding previous SLMB programs.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  AFFORDABLE INSURANCE QUOTES UPDATED ON MAGI APPENDIX G

MANUAL REVISION: #17

APPENDIX G

DISCUSSION:

The purpose of this memorandum is to notify staff that Appendix G has been updated with 2020 insurance quotes from the Federally Facilitated Marketplace (FFM).  Affordable insurance determinations for CHIP premium children must still be completed with the CHIP Affordability Test Calculator (MAGI Appendix G).

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/df

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITIES (CARES) ACT IMPACT OF SMALL BUSINESS ADMINISTRATION (SBA) LOANS AND GRANTS TO ADULT AND FAMILY MO HEALTHNET PROGRAM PARTICIPANTS

DISCUSSION:

The CARES Act Public Law No: 116-136 was signed on March 27, 2020 to provide economic relief for small businesses impacted by the COVID-19 pandemic. Per guidance in Title I of the CARES Act, the SBA is issuing specific loans and grants to small businesses to cover the cost of wages, paid leave, and other COVID-19 related expenses, and is limited exclusively to business related expenses rather than personally supporting the business owner.

Although there may be a measure of loan forgiveness for business owners receiving funds under the CARES Act when specific requirements are met; per 20 C.F.R. 416.1103(f), cancellation of a debt cannot be considered as income to be used to meet the participant’s needs for food or shelter.

Section 1106(i) of the CARES Act also states forgiveness of loans will not trigger any personal tax liability. Per 20 C.F.R. 416.1201(a), these loans and grants are not considered as income or a resource for Adult MHABD programs. Due to the structural requirements of the SBA loans and grants made available through the CARES Act per Section 1102(a)(36)(F), funds received will not be considered as income for Adult or Family MO HealthNet programs, or as a resource for any Adult MO HealthNet program.

Please refer to policy in the December 1973 Eligibility Requirements manual, under section 1025.015.14 Proceeds From a Bona Fide Loan, and 1025.015.06 Business Accounts in Financial Institutions for all adult MHABD programs and treat as a bona fide loan, except SBA loans and grants will not be counted as income in the month received, or as a resource even if retained into the following month.

Please refer to policy in the Family MO HealthNet (MAGI) manual section 1805.030.20.10 Income Excluded Under MAGI and treat SBA loans and grants as a bona fide loan.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vm

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  FILLABLE PDF VERSIONS OF PRESUMPTIVE ELIGIBILITY (PE) FORMS

FORM REVISION #10  

PE-2 Worksheet
PE-3
PE-3 TEMP

DISCUSSION:

The purpose of this memo is to introduce fillable PDF versions of the:

• Qualified Entity Presumptive Eligibility Determination Worksheet (PE-2 Worksheet);
• MO HealthNet Presumptive Eligibility Authorization (PE-3); and
• MO HealthNet TEMP/SMHB-PE Authorization (PE-3 TEMP)

These three forms, along with the previously released Application for Presumptive Eligibility (PE-1SSL) will be made available to all Qualified Entities.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/df

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) TICKET TO WORK HEALTH ASSURANCE (TWHA) PREMIUM REDUCTION DUE TO THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT (FFCRA)

MANUAL REVISION # MHABD Standards Appendix J

DISCUSSION:

On March 18, 2020, HR 6021 Families First Coronavirus Response Act (FFCRA) (Pub. L. 116-127) was signed into law. Section 6008 of the FFCRA states eligibility requirements will not be more restrictive than they were in January 01, 2020.

Effective April 01, 2020 and ongoing during the COVID-19 National Emergency period, the premium rate increase with the Federal Poverty Level (FPL) adjustment, will be reduced back to the premium rate tables required as of January 01, 2020. This change is effective immediately, and impacts all TWHA premium level participants as well as new TWHA approvals since April 01, 2020.

Participants will be notified of the premium reduction, and corrected invoices will be generated as needed. Participants will also be notified of the effective date of the premium rate increase back to the FPL 2020 premium amounts when the public health emergency ends.

Appendix J has been revised to reflect the premium rate requirements for TWHA participants during this time.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vm

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 FAMILY HEALTHCARE (MAGI) CHIP 75 THIRTY DAY WAITING PERIOD WAIVED

DISCUSSION:

Waive the thirty day waiting period for participants approved for Children’s Health Insurance Program (CHIP) 75 for any application received on or after March 18, 2020.  Enter CHIP Special Needs evidence in MEDES to prevent the thirty day waiting period while still allowing MO HealthNet Division (MHD) to send invoices.     

Application Case:

• CHIP Special Needs evidence is tied to Application Details. The current Yes segment for the CHIP 75 child(ren) must be selected when creating this evidence.
  • When going through the caseworker portal this evidence will be created when the Application Case is submitted based on the questions in the portal.
• Leave the box blank labeled “Require Verification, even if evidence does not indicate eligibility for CHIP 75?” in the CHIP Special Needs evidence. Verify evidence on the Application Case and run Check Eligibility.  If an applicant looks to be CHIP 75 eligible verification will create for the CHIP Special Needs.
  • Use the verification item “MHD Administration Request”.
  • Include a comment with the label COVID-19 stating, “Special Needs entered due to special circumstances. 42 CFR 435.952(c)(3).”
    • During COVID-19 we are not requesting any Special Needs verification.
  • If an IM-31A needs to be sent for other pending items on the case this can be sent, but do not include the CHIP Special Needs on the request.
  • If able to Authorize the Application Case run Check Eligibility again after all the items to verify are cleared and then Authorize the Application Case.
    • There will be no thirty day waiting period now for the CHIP 75 child(ren).

Integrated Case (IC):

• CHIP Special Needs evidence must be tied to the current Yes Application Details segment for any child(ren) who may be CHIP 75 eligible. To create CHIP Special Needs and tie it to the Application Details evidence:
  • Add the CHIP Special Needs via the Dashboard, which is found under Application Details.
    • Select the current Application Details Evidence for the potential CHIP 75 child.
    • Use the default date for Received Date. MEDES will auto populate the start date when reviewing the evidence to the last Yes Application Details segment.
    • Leave the box blank labeled “Require Verification, even if evidence does not indicate eligibility for CHIP 75?” in the CHIP Special Needs evidence.
    • Select Save.
    • Repeat for any child who may CHIP 75 eligible.
  • If an IM-31A needs to be sent after verification is completed follow the process of not Applying Changes.
    • If the verification comes back the follow-up will verify the evidence and Apply Changes.
    • Once Apply Changes are completed MEDES will create CHIP Special Needs to be verified.
    • Use the verification item of “MHD Administration Request”.
    • Include a comment with the label COVID-19 stating, “Special Needs entered due to special circumstances. 42 CFR 435.952(c)(3).”
      • During COVID-19 we are not requesting any Special Needs verification.
    • Apply the verified CHIP Special Needs evidence to the IC, review proposed determination, and Finalize.
  • If no IM-31A needs to be sent Apply Changes to the IC.
    • After Changes are applied MEDES will create CHIP Special Needs to be verified.
    • Use the verification item of “MHD Administration Request”.
    • Include a comment with the label COVID-19 stating, “Special Needs entered due to special circumstances. 42 CFR 435.952(c)(3).”
      • During COVID-19 we are not requesting any Special Needs verification.
    • Apply the verified CHIP Special Needs evidence to the IC, review proposed determination, and Finalize.
      • There will be no thirty day waiting period for any child who is CHIP 75 eligible.
    • Coverage will begin the date the premium is received.
    • Applications that have already been approved will be corrected and do not require further action by staff.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/kg/ns

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF STATE AND FEDERAL GOVERNMENT DISASTER RELIEF PAYMENTS POLICY FOR MO HEALTHNET FOR THE AGED, BLIND AND DISABLED (MHABD)

MANUAL REVISION #14
0805.015.10
1025.015.01.01

DISCUSSION:

The purpose of this memorandum is to introduce a policy addition to the December 1973 Eligibility Requirements manual, 1025.015.01.01 State or Federal Government Disaster Relief Payments.

These sections address whether to include or exclude disaster relief payments as income and/or resource.

Payment sources can be from:

• Federal Emergency Management Agency (FEMA)
• State Emergency Management Agency (SEMA)
• National Flood Insurance Act of 1968 (NFIP)
• Disaster Relief and Emergency Assistance Act (P.L. 100-707), or
• Any income received from an insurance company or agency due to a State or Federal government emergency disaster.

Refer to these sections when State, Federal Government disaster relief payments are in question or affect eligibility for MHABD.

This policy is not to be referenced for the Economic Impact Payments (Stimulus Payments from COVID-19 Federal Emergency). A memo referencing the Economic Impact Payments will be posted soon.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/nw